Pain Warriors Unite - (202) 792-5600

Pain Warriors Unite

Calling ALL Pain Warriors, It's NOW or NEVER!

image9

ANALYSIS OF HHS UPDATED OPIOID GUIDANCE

HHS released a Guide of WHEN, HOW, and IF it's appropriate to TAPER opioid pain medications.  


PLEASE DO NOT instantly decide this is negative! 


Finally the CORRECT (parent) agency, HHS is speaking out and setting OFFICIAL guidelines that will set the PRECEDENT for best practices. 


HHS' assistant secretary for health Dr. Brett Giroir urged clinicians to COLLABORATE with patients on deciding how fast they reduce or stop their opioid therapies.

"We know that it is CRITICAL that clinicians manage acute and chronic pain in an INDIVIDUALIZED, patient-centered way"


This allows us to report those who do not taper appropriately, for legitimate reasons, or in collaboration with the patients wishes.

This is the First OFFICIAL GUIDE that lists requirements for OUD and acknowledges that tolerance & withdrawal do not equal sufficient criteria to diagnose us with OUD.  Thus the beginning of decriminalizing ‘physical dependence’ on a national level! Most documents & definitions omitted that little caveat, leading to many incorrect OUD diagnoses in pain patients.

✅ It mentions that some patients on BOTH benzos and opioids DO NOT need to be tapered.

More than 1/2 of the references are studies that support us, which means they can no longer say we do not have good info to PROVE HARMS of tapering.

✅ It reiterated that CDC limits should NEVER be used as STATE LAW/POLICY to deny or taper patients. Also mentions insurance and pharmacies have increasingly caused patients to be cut off abruptly, hopefully that will be addressed soon!

This finally gives us an idea of how many on LTOT (Long Term Opioid Therapy) - 8,100,000 or 4% of the population. Remember that we ARE the MINORITY needing higher doses over 90mme.

Even the flow chart says to only taper if risks outweigh benefits, and to re-evaluate every 3 months, that could reduce the number of appointments for many!

✅ Another HUGE thing is that it also says before tapering, there needs to be ACCESS to EFFECTIVE and AFFORDABLE alternatives. For many of us that does not exist, so it could also protect from forced tapers!

Common tapers range from reducing opioids dosage between 5% and 20% every four weeks, but HHS recommends reducing dosage by 10% per month or slower for patients who have used opioids for more than a year.


Most of all, it sets a standard that should greatly REDUCE the number of forced, rapid tapers and abandonment because this guide could be used AGAINST prescribers & medical boards that encourage prescribers to ignore this guidance! 


"Clearly, we believe that there has been a misinterpretation of the [CDC] guidelines, which were very clear," Giroir said. "People have inappropriately misinterpreted cautionary dosage thresholds as mandates for dose reduction." Giroir said.

Press Release from HHS:

https://www.hhs.gov/about/news/2019/10/10/hhs-announces-guide-appropriate-tapering-or-discontinuation-long-term-opioid-use.html?amp&__twitter_impression=true


Link to Report:
https://www.hhs.gov/opioids/sites/default/files/2019-10/8-Page%20version__HHS%20Guidance%20for%20Dosage%20Reduction%20or%20Discontinuation%20of%20Opioids.pdf 





Summary:


HHS' assistant secretary for health Dr. Brett Giroir urged clinicians to collaborate with patients on deciding how fast they reduce or stop their opioid therapies.

"We know that it is critical that clinicians manage acute and chronic pain in an individualized, patient-centered way," Giroir said.

There have been numerous reports of individuals being abruptly cut off their medication regimen after the Centers for Disease Control and Prevention's Guideline for Prescribing Opioids for Chronic Pain in 2016, according to Giroir.

The CDC guidelines recommended clinicians prescribe opioids only after exhausting other pain therapies, prescribe the lowest effective dosage, evaluate patients within 1 to 4 weeks of starting opioid therapy for chronic pain, and taper or discontinue opioids if the harms OUTWEIGH the benefits.

"Clearly, we believe that there has been a misinterpretation of the [CDC] guidelines, which were very clear," Giroir said. "People have inappropriately misinterpreted cautionary dosage thresholds as mandates for dose reduction."


News Reports:


HHS Warns Doctors To Not Swing Too Far On Pendulum Away From Opioids For Chronic Pain Patients


As the country grapples with the opioid epidemic, there's been a broad crackdown on opioids in general. Now, HHS is urging doctors not to go too far in cutting off prescriptions. Other news on the crisis focuses on the court challenges to Purdue Pharma and other drugmakers.



The Associated Press: US Urges Shared Decisions With Pain Patients Taking Opioids

U.S. health officials again warned doctors Thursday against abandoning chronic pain patients by abruptly stopping their opioid prescriptions. The U.S. Department of Health and Human Services instead urged doctors to share such decisions with patients. The agency published steps for doctors in a six-page guide and an editorial in the Journal of the American Medical Association. (Johnson, 10/10)


The New York Times: Health Officials Urge Caution In Reducing Opioids For Pain Patients

After more than 300 medical providers, pharmacists, patient advocates and others emphasized these concerns in a letter to the C.D.C. earlier this year, the agency put out a clarifying statement saying the guidelines did not “support abrupt tapering or sudden discontinuation of opioids,” and warning doctors not to misapply them. The new tapering guide goes deeper, detailing the potential harms to patients who abruptly stop taking opioids and laying out factors to consider and steps to take before starting a taper. It includes several examples of tapering protocols. (Goodnough, 10/10)


NPR: Don't Force Patients Off Opioids Abruptly, New Guidelines Say, Warning Of Severe Risks

"It must be done slowly and carefully," says Adm. Brett P. Giroir, MD, assistant secretary for health for HHS. "If opioids are going to be reduced in a chronic patient it really needs to be done in a patient-centered, compassionate, guided way." This is a course correction of sorts. In 2016, the Centers for Disease Control and Prevention issued prescribing guidelines. Those highlighted the risks of addiction and overdose and encouraged providers to lower doses when possible. In response, many doctors began to limit their pain pill prescriptions, and in some cases cut patients off. (Stone and Aubrey, 10/10)


The Washington Post: New Guidelines On Opioid Tapering Tells Doctors To Go Slow

Millions of people in the United States — an estimated 3 to 4 percent of the adult population — take opioids daily. About 2 million people have been diagnosed with prescription opioid use disorder, according to HHS. There is a consensus in the medical community that these painkillers have been overprescribed and that many patients would have better long-term health outcomes if they cut back on their dosages and took advantage of other types of treatment, ranging from physical therapy to nonnarcotic painkillers. (Achenbach, 10/10)


Modern Healthcare: HHS Gives Physicians Guidance On Tapering Patients Off Opioids

HHS' assistant secretary for health Dr. Brett Giroir urged clinicians to collaborate with patients on deciding how fast they reduce or stop their opioid therapies. "We know that it is critical that clinicians manage acute and chronic pain in an individualized, patient-centered way," Giroir said. (Johnson, 10/10)


Stat: With A New Guide To Tapering Opioids, Federal Health Officials Seek A Balanced Approach To Prescribing

The anxiety around prescribing built in response to the opioid crisis, which drove more than 47,000 fatal overdoses in 2017 alone. The crisis was caused in part by some clinicians overprescribing the drugs, leading to cases of addiction in patients and a source of pills that were diverted. Prescribing levels have dropped since 2012, and some advocates have warned that the fear around opioids has left some patients unable to get them. (Joseph, 10/10)

image10

Pain Management Task Force Final Report overview

RE: Overview of Pain Management Task Force Meeting & Final Report 



View Task Force's Final Report HERE


The purpose of this final meeting was for the Task Force members to disseminate and discuss the final report in full detail. They debated and deliberated to carefully refine the language and terminology to avoid future misinterpretation or misapplication. They reviewed the consensus of thousands of comments submitted by the public during the previous public comment

Summary:



Click Below for our Summary of the Meeting 

image11

HHS PAIN MANAGEMENT TASK FORCE FINAL REPORT

We need to get the HHS Pain Task Force's Report into the hands of EVERY State & Federal Legislator, State Regulators, and Media ASAP!


There are a couple of ways to do this:

 

You can share the link to the REPORT with Members of Congress & National/Local Media contacts' Facebook/Twitter pages & underscore the urgency of our need for a National Pain Policy. (See Links Below)


Also,  you can CALL your Representatives & ask for the Health Care Staffer's Email address and tell them to expect to receive an urgent email with the Task Force Report. Make sure to follow up the next day to request a meeting to discuss implementing our National Pain Policy. 


Remind them that #PainPatientsVote & we have HUGE numbers to sway 2020 election!


Find out how to Contact Your Representatives HERE

TASK FORCE REPORT HEREhttps://www.hhs.gov/sites/default/files/pmtf-final-report-2019-05-23.pdf


List of Twitter & Facebook Accounts for U.S. CONGRESS:

https://triagecancer.org/congressional-twitter-handles

U.S. Senators: https://twitter.com/cspan/lists/senators?s=09


U.S. Representatives: https://twitter.com/cspan/lists/u-s-representatives?s=09


As always be respectful,  but persistent. 


#PMTF #PainAwarenessMonth #endpainpatientabuse #illicitFENTANYLcrisis #PainPatientsVote 



Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations


The Comprehensive Addiction and Recovery Act of 2016 (CARA) required the Pain Management Best Practices Inter-Agency Task Force to develop the Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations - PDF*, which identified gaps or inconsistencies, and proposed updates to best practices and recommendations for pain management, including chronic and acute pain.



HHS Blog: Patient-Centered Care Is Key to Best Practices in Pain Management by Dr. Vanila M. Singh, MD, MACM


Final Report Resource Kit


This Resources Kit includes a set of factsheets and infographics that summarize information from the Report that can help communicate recommendations for improving pain management. The resources below are listed by pain management related topic areas. Click the links below to download the PDF of each type of resource. These resources can be used in PowerPoint presentations, newsletters, or on social media accounts.


  • Overview – of the PMTF Report findings and background on the Task Force's efforts to improve best practices for acute and chronic pain management in light of the ongoing opioid crisis. Factsheet - PDF


  • Policymakers – at the Federal and State levels play a critical role in improving lives of chronic pain and advancing policy considerations identified by the Task Force. Factsheet - PDF


  • Special Populations – with unique challenges associated with acute and chronic pain, include children/youth, older adults, women, pregnant women, individuals with chronic relapsing pain conditions, racial and ethnic populations, active duty military, reserve service members, Veterans, patients with cancer-related pain, and patients in palliative care. Factsheet - PDF


  • Access to Care – learn more about the barriers such as lack of coverage, medication shortages and pain management specialists and stigma. Factsheet - PDF and Infographic - PDF


  • Stigma - can serve as a significant barrier to adequate treatment of pain – and can affect patients, families, caregivers, and even clinicians. Factsheet - PDF and Infographic - PDF



  • Education - for patients, clinicians, and policymakers is critical to the delivery of effective, patient-centered pain management. Factsheet - PDF and Infographic - PDF

Downloads PMTF

Documents pertaining to the Pain Management Task Force